What does this research mean for the field?

Implementing an electronic health record alert for elevated FIB-4 increases provider documentation of liver fibrosis risk but does not significantly increase orders for confirmatory testing, indicating alerts alone are insufficient to change clinical practice. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This project aims to evaluate whether EHR alerts for elevated FIB-4 can improve liver fibrosis screening in individuals with diabetes.

June 7, 2026

2930-LB: Implementation of FIB-4 Alerts in EHRs to Increase Screening for Liver Disease

Key Points

This project aims to evaluate whether EHR alerts for elevated FIB-4 can improve liver fibrosis screening in individuals with diabetes.
Pre-intervention data gathered from new patients at a weight loss clinic (July-August 2025).
EHR alerts flagged patients with certain health metrics (BMI≥30 kg/m2, A1c≥5.7%, FIB-4≥1.3).
Post-intervention data collected from December 2025 to February 2026.
FIB-4 referenced in notes increased from 1.1% pre-intervention to 9% post-intervention (p=0.002).
50.5% of post-intervention patients had labs required to calculate FIB-4 within 1 year, up from pre-intervention.
No significant change in orders for ELF or elastography was observed.

Abstract

Introduction and Objective: Recent ADA guidance recommends screening individuals with T2D for liver fibrosis with FIB-4 index followed by confirmatory testing. However, implementation of these recommendations remains low. This project assessed whether an electronic health record (EHR) alert for elevated FIB-4 improved screening for liver fibrosis. Methods: Pre-intervention data were gathered from all new patients seen in a weight loss clinic in July-August 2025. An EHR alert flagged patients with BMI≥30kg/m2, A1c≥5.7%, and FIB-4≥1.3. Post-intervention data were collected from 12/2025 to 2/2026. Outcomes included documentation of FIB-4 in clinic notes and orders placed for fibrosis-related labs (e.g., ELF) or imaging studies (e.g., elastography). A 1-hour education session for providers has recently been conducted, and similar data gathering for a post-education phase is ongoing. Results: Pre-intervention data included 178 new patients (45±13 years, 78.7% female, BMI 41.8±9.6 kg/m2, A1c 6.0±1.2%, 23% had diabetes, 7% had elevated FIB-4). FIB-4 was mentioned in only 2 (1.1%) notes. Additionally, 88 (49.4%) patients had labs within 1 year prior to calculate FIB-4, while 41 (23%) had the required CBC and CMP ordered on the day of visit. Post-intervention data included 111 new patients (45±15 years, 82.9% female, BMI 41±8.3 kg/m2, A1c 5.8±1.2%, 18% had diabetes, 9% had elevated FIB-4). FIB-4 referenced in notes significantly increased to 9%, p=0.002 compared to preintervention. Fifty-six (50.5%) of these patients had labs required to calculate FIB-4 within 1 year prior, while 15 (13.5%) had labs ordered on the day of visit. No significant changes in ELF or elastography orders were observed. Conclusion: Implementation of a FIB-4 alert increased awareness about liver fibrosis screening, but it did not substantially change providers’ practices. Alerts alone may not be sufficient to improve fibrosis screening in obesity clinics. Ongoing efforts include targeted provider education to assess whether combined strategies enhance liver fibrosis screening. Disclosure S. Bobba: None. J. Nammi: None. K. Cohn: None. M.E. Gray: Consultant; Current; Novo Nordisk, Boehringer Ingelheim International GmbH, Madrigal Pharmaceuticals, Inc. Consultant; Ended; Intercept Pharmaceuticals, Inc. F. Bril: Consultant; Current; Novo Nordisk. Advisory Panel; Current; Novo Nordisk. Consultant; Current; Madrigal Pharmaceuticals, Inc. Advisory Panel; Current; Madrigal Pharmaceuticals, Inc. Consultant; Current; Boehringer Ingelheim International GmbH. Advisory Panel; Current; Boehringer Ingelheim International GmbH. Funding Petauri Kinetix

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